She is so cute, I'm gonna die!

Genius

Here's to the crazy ones. The misfits. The rebels. The troublemakers. The round pegs in the square holes. The ones who see things differently. They're not fond of rules, and they have no respect for the status quo. You can quote them; disagree with them; glorify or vilify them. About the only thing you can't do is ignore them. Because they change things. They push the human race forward. And while some may see them as the crazy ones, we see genius. Because the people who are crazy enough to think they can change the world are the ones who do.
-Apple "Think Different" Campaign


This definitely reminds me of someone

Pappy's makes top 101 BBQ

http://www.bizjournals.com/stlouis/blog/2011/08/pappys-smokehouse-named-best-bbq.html
Yum!

Joplin Trip

Just came back from a trip to Joplin organized by my church.  I had no idea what to expect, but I was still surprised by all the destruction that took place and how disastrous the houses, the lands, and the buildings looked.  It was especially disturbing to see the hospital completely deserted and the high school imploded upon itself as if someone punched it from the top.  Yet, despite it all, there were bulldozers demolishing old buildings, fresh new stores that still retained the smell of a recent paint job, and volunteers standing in 100 degree weather painting colorful murals that standout against the rest of the town.

Our job was pretty simple - didn't require too much thinking, but just required a bit of physical labor and happy conversation with the other volunteers.  There were 23 of us total, ranging from business man to cupcake manager, from improv instructor to Six Flags event planner.  It was a good group of people, and we had our share of fun sharing our lives and enjoying the hot or cold weather.  We mostly cleaned up various lots that had branches, shingles, metal pieces, and whatever you can think of scattered about the land.  There was a lot of bending down and raking that resulted in some very sore backs and hamstrings.

One of the families had a house that was deemed irreparable, so the whole house was knocked over.  But there was one shack that looked like a miniature barn that remained standing and required some fixing.  However, the only person who knew how to fix it was the 80-something father who wasn't the lightest of the bunch.  He definitely knew his shed well given that he built it himself some 5 years ago, but given the 100+ degree weather, no one else thought it was wise for him to be climbing on a teetering ladder 10-20 feet above the ground.  So, we heard their story, and helped them fix up the shed with some screws, hammers, and saws.  Turns out the father had actually been a cowboy in his younger days, retired with no house or compensation, worked with habitat for humanity, and eventually obtained a shotgun house from them.  During the storm, he was away, and fortunately his daughter and her husband were safe.  The insurance, however, refused to acknowledge that house was bad enough that it needed to be rebuilt, so they have refused to pay up.  Now they have lived from hotels to trailers.

Another family we worked with needed rocks to be picked up.  Although initially sounding like a non-glamorous job, we discovered a great story.  The son had actually moved to the area a month before, and he considered it a blessing because otherwise, he would've had to drive down 15 hrs with no job, no friends, and a great amount of anxiety.  His parents, who were living in Joplin locked themselves in a closet, and fortunate for them, only the other half of the building was the most damaged.  Thankfully, they had legit insurance, and they are on their way to rebuilding their house.  However, their many acre land used to be a complete forest, and now you can see clear across it.  They needed rocks to be removed because when the trees were uprooted, they brought up with them a lot of rubble.  They still had 3 adorable goats and 9 chickens left, while the rest were lost in the tornado.  One goat, Avalon, was found wandering many blocks away.  Meanwhile, the son who worked as a top chef in the area (and worked alongside Masahuru Morimoto from Iron Chef), told us the difficulty of feeding hundreds of people without electricity and other conveniences after the storm.

We were demolishing the ruins of another house, when one member of the group found a business card with the owner's name and contact info.  She contacted them, and found that it was a reverend and his wife.  Some of their belongings were salvaged from the ruin - things that they had thought they would never see again.

Other interesting things:

• One of the volunteers is building a humongous steel archangel in Joplin.
• When asked what was the one thing people would change about Joplin, most people said to have the trees back.  (b/c Joplin used to be very heavily forested).
• 18+ people survived in a gas station beer cooler: http://www.abovetopsecret.com/forum/thread708605/pg1 It's interesting to hear one person calling "I love everyone, man" and someone else calling out "Jesus."

Pray for all those families who experienced losses!

Fun stuff on the trip:

• Waterfall in Joplin
• Visit Chicken Annie's
• Three Corners (Oklahoma, Kansas, Missouri)
• 16-hr cooked BBQ: so tender, amazing sauce.  Apparently the sauce is so secretive that it's locked away in the man's father's safe and the man who made this won't get the recipe till his father passes away.  He also has to buy the sauce from his father!

Blonde, Asian, non-smoking pharmacist named Deborah

Apparently these are the traits of high earning women:

• Named Deborah
• Asian, blond (i'm assuming it's "or" as opposed to "and", unless there are blond asians, which is just weird)
• Born in Westlake, TX
• Attractive - maybe I should start putting on those fake eyelashes
• Tall - hm...what if i'm tall in asian standards?
• Left-handed
• Non-smoker
• Single and childless
• Eldest child
• Pharmacist, more educated
• Assertive - darn, i gotta work on this one
• Drinker - really? man, this doesn't fit well with being asian.  It's like an oxymoron.
• Current residence of Washington DC
• Good credit report
• 25 lb lighter than average weight for height - Seriously? That would make me anorexic - seriously, that's just not right.

Okay, sure, certain traits are good to make more money...but at the expense of the valuable things in life is just not worth it.

Here's the full article: The Women with the Highest Earning Potential

Ob/Peds in Sierra Leone

Here's an inspirational article about improvement in ob/peds in Sierra Leone! http://www.nytimes.com/2011/07/18/world/africa/18sierra.html?pagewanted=2&_r=1 (thanks YW)

3rd year Summaries of Rotations

In general: I asked too many stupid questions - yes, there is such a thing.  If it's a question where you can just look it up - then note it and look it up later.  Better to ask questions that aren't easily looked up.  Even better to look up something, and say, "I was reading this paper...and didn't understand..."  Also figure out people's personalities.  If they don't like questions, don't ask so many questions! - i can't seem to get this right.


Psychiatry: it was a very fascinating rotation.  Got to see some things that most people would never ever see and probably never will see even if they're doing medicine just because everything's locked up.  I've definitely had a change of mind about psych.  I came in mostly skeptical about the "science behind it all" and the validity of using medication on all these seemingly personality related issues, but when you actually see these people, you know there's something else going on.  And it's AMAZING what a big change the medicine makes, sometimes just in the course of a day!  From the rambling, incoherent, suicidal lady who looks deathly distressed and disheveled to the joyful, upbeat lady who jokes with me and says I should go into psychiatry - all in 3 days.
Things that I could do: preround each morning, speak with patient's families, get previous hospital records (fax or  ask awesome social workers for help), help put in orders, help put in discharge orders, help write up discharge dictation notes.  For preround, it's good to look up labs, and flowsheet/psych notes from nurses (ask where they are under flowsheet).  Note abnormal lab results. For call, good to go down to ER to take history (b/c can take a while for them to get up to the floor).  Work with other med students on your team to present an article on certain days (maybe each week) - makes everyone happy.

Neurosurgery: Well, I had a resident who was very busy and walked really fast, so I often got lost, and didn't have much to do except listen.  I think I could've done a better job listening during rounds because I knew stuff about my patient, but I just couldn't hear their question to answer them. Sighs.  Well, know the patients, know their history, labs (results in compass and microbiology in clindesk), and imaging (ddx) in clindesk.  Also know normal values for LP pressure (5-15), and basic important things like m/c cause of strokes, etc. Chief residents know their stuff - listen/watch them well.  During operations, it's good to scrub in and watch from up close, even though you might not feel like you can do much (know how to tie knots! practice! - esp one-handed ones).  During prep/post surgery, help anesthesia and help move the patient.  Might need to watch well the first time, and then help out.  Anesthesia's always willing to teach, so it's good to ask them if you can help.  Also, you'd be surprised how much some of the tech's know - especially those monitoring that movement is still normal (Somatosensory evoked potentials).  They can teach a lot! This one guy essentially gave me a play-by-play of this one surgery + other nifty info.  Learn to speak succinctly on presentations of patients.  Very big difference from the nice/friendly atmosphere of psychiatry.  You have to be really alert/keen about what you can do.  Never ask a surgeon about bleeding (ya...my mistake).

Neurology Inpatient: Well, enjoyed it enough that I'm not crossing it off my list of potentials.  I definitely liked spending more time with patients and thinking more about each case.  I find that I really enjoy thinking about things - maybe that points me towards medicine more than surgery? Who knows.  A lot the cases were MS and seizures, but there were definitely a lot of cases where people got discharged, moved to another service, coded, or whatever...and we never really truly understood what they had.  I think that might be a plus or a minus.  The minus is that well, you don't always know what the patient has.  But the plus is that it gives some purpose to the physician aside from just treating each individual patient.  It's definitely a field that's constantly improving - kind of like psych.  There are just still so much unknowns about the brain left to be discovered.
In terms of the team, I really enjoyed working with everyone.  The attending was really friendly and greatly enjoyed teaching, and I was really fortunate to have an awesome chief resident who took the time take us aside and teach us for an hour.   Even though the junior residents were really busy, it was still a pleasure to work with them, whether it was just helping them out with the gargangium amount of stuff they had to do, learning tidbits, or receiving advice on how to improve.  It felt like me, being the slow and steady type of person, could fit in.  Although I did get the criticism that I tended to focus on the details and forget about the big picture and plans/management for the patient.  And since I'm a student, I should use the extra time I have to really work out the differential and consider all the angles/possibilities.  It's true - by the time I get down to the assessment and plan, I just want to be done with it.  One thing I regret not doing on this rotation was an LP.  It's a shame, I probably ended up watching 7 or 8, but each time when I asked if I could try the LP, it was either a bad patient (too large), there were complications, I had lecture, or the resident needed to do it because he/she hadn't done it yet.  Sighs.  Hopefully I'll get to do one in the ER next rotation.

ER: What do you know, I got to do an LP! That was really exciting.  Even more exciting was that it was successful.  ER was a load of fun.  Being able to see all these different cases, and coming up with the most dangerous ddx was fun, but also sometimes made me a big skeptical.  I mean, the lady with the fatigue and bilateral leg edema - do you really think that's a pericardial effusion when her heart/lungs sound fine?  I suppose it's better to be safe than sorry.  I also found that I LOVED seeing babies on ultrasound.  Hm...maybe this means something?  But then again, I also LOVED suturing. I could take forever.  It reminds me of sewing and knitting - but flesh. Okay, that picture's getting gruesome.  Anyhow, I can see myself doing ER.  A lot of what they do seem like protocol than actual quick decision making, but I'm sure things are different in the more traumatic areas of the ER.  We'll see, I'll probably need to do another shift next year, although I gotta say it does kind of bother me not knowing what happens to the patients (granted I could just look it up).  I think I like more continuity.  Maybe.

Pediatrics: I LOVE KIDS!  They are just so adorable! I don't see how anyone can not like kids.  Just walking through Children's Hospital gives me a warm fuzzy feeling.  Maybe a part of me is still very much a kid, so I get drawn to the bright colors and the cool contraption of the rolly balls going up and down.  Even being in heme/onc wasn't as sad as I had thought.  The kids are just so resilient, and they are so bright compared to adults.
I've been a little more concerned about interacting with teenagers, but so far, they've been okay.  They can be a little terse.  I find I go into my little kid voice and sometimes continue to talk in that voice to the parents - oops.
I thought I was going to looooove babies, and well, yes I do.  Just holding them in my arms and watching them sleep is like watching a little angel.  I just want to cuddle them all day!  But what made nursery difficult was having to work with the mothers and prepare them for motherhood - for which many were definitely NOT prepared.  It's so sad sometimes.  There are these innocent, perfect, beautiful babies, and you have to hand them over to who knows what kind of world is out there.  Well, I guess that's life.
Lessons learned:

• Don't throw/erase things unless I'm SURE they aren't needed - backup is good.
• Don't put bad things in the differential because OB is very tense about litigations
• No disclosures! - talk to residents first.
• Write a lot, talk little

Rotation Memorable Moments

Memorable moments from my rotation and the rotations of my friends:

• Psych
• Early teen's high functioning asperger's kid who's been drawing ideas for horror tv shows since age 4. Plots include murder, rape, violence, etc.
• Manic patient runs out of room saying "they're trying to get me," gets stopped/calmed down by a nurse, and ensues to hug the nurse and me.
• Manic patient repeatedly cries out, "I'm ready to talk"
• Manic patient pulls out imaginary string from my pants and coils it in her hands.
• The attending was speaking to the mother about her son.  All of a sudden, the son gets up, asks his mom if he could tell her a secret.  The kid whispers something to his mom, and sits back down.  The mom turns to me, and says her son wanted to say something to me.  The kid smiles widely and says, "Konichiwa."
• My patient asked me to button up my white coat (apparently I was dressed too provocatively - note the sarcasm)
• A patient refused to talk to me because, my bangs were in my eyes.
• A guy getting anesthesia before ECT got stuck in both arms, both feet, and both sides of neck to put in an IV line.  Ultimately they still didn't get a line and he had to go home to return to get a port placed on another day.
• Patient believes Eminem fathers her children, Eminem's songs were written by her, and he had left a letter in the wall of her building, so she tore up the wall with a sledge hammer.
• Patient believed the FBI had tapped his house and listens to him, wife's friends are after him, wife had put shards in child's hands, and wife is dating a teenager.
• Interviewed a patient for almost 2 hrs because he had latency of 5-10sec, and kept being distracted by dots.
• Almost 100yo cute old lady who thinks she's engaged to Tom Brokaw
• Twin autistic kids. One of them has a tic of bending at the waste when watching something on iphone/computer.
• Trazadone guy: "trazadone?! do you have any trazadone?! doctor can you give me some trazadone?!"
• Lady who shouts obscenities in low, monstrous, husky voice.  And believed someone had shot her in the leg and back, that people were coming after her from her closet, and that she was pregnant.
• Guy who burst into rage, obsenities, and threats while a lot of residents/students watched from a corner.
• Being told by ob/consult that it's not appropriate for a medical student to call consult.  It's alright, the resident backed me up :D
• Neuro:
• 14 yo's response when asked about anxiety and mood: "some anxiety, but not clinically significant" - turns out a parent is a psychiatrist.
• Discussing neuro exam on kids: "well there isn't really much you can assess for in terms of higher cognitive function - they eat, they sleep, they cry, and they make baby movements." (so cute!)
• Achondroplasia baby with hydrocephale - enormous head, very happy baby
• Neurofibromatosis 1: neurofibromas all over - some really soft
• Von Hippel Lindau syndrome: many hemangioblastomas in brain
• Cushing's: striae, gynecomastia, weight gain, moon face, renal failure from ibuprofen for headaches
• Left ICA, right ACA infarction - didn't know had stroke b/c under sedation
• Radiation induced meningiomas; hemiparesis, dysphasia, many things...
• Pilocytic astrocytoma in young adult, spinal ependymoma, HIV + meningioma surgeries.
• Na of 203 b/c of paraneoplastic syndrome!
• 4 patients started seizing within one hour and one coded.
• Attempting an LP on BMI of 70
• Leptomeningeal carcinoma - sarcoid? meningioma? ???
• Melanoma brain metastasis + lung cancer
• Huge list of PMH + ESRD/HD + endocarditis + bacteremia + delirium + no pupil constriction
• ADEM vs. MS + unresponsive/no blink to corneal reflex
• Guillain Barre vs. DM
• ER:
• Finally got to do an LP (successful too!) after watching a bijillion and not allowed to do them b/c the patient was too difficult (let's just say the needle had to be long).
• Pelvic exam, check anal tone, all that good stuff
• Dude with 5 fingers lacerated b/c of band saw - finger krooked, see tendon, etc.
• Reducing a dislocated shoulder - oh man, people under some sedation are pretty amusing.
• Suture laceration on arm and face - I love suturing!
• Held a live, beating heart between my two hands. 
• Stapled it, made it go into fibrillation with a battery, and then pumped it with two hands.
• Started an IV while patient screamed "Ahhhhh" and "Heeeeelp."
• Peds:
• Epidermolysis bullosa - fingers fused together, whole body wrapped up, can't talk clearly because corners of mouth fused, skin was so fragile that rubbing it would cause it to slough off and blister.
• Little guy with optoclonus/myoclonus + ganglioside neuroblastoma
• Girl with GVHD (MDS txp): white skin patches, hair loss, tear duct
• Hurler syndrome, BMT, hypogammaglobulinemia: gargoylism, large tongue, corneal clouding, HSM, contractures, running nose, heart/lung issues
• Fanconi Anemia: short, cartilage/finger thumb, skin, horseshoe kidney, AA/AML, BRCA gene
• Unknown: hard nodules all over + fibrosarcoma + contractures + unknown brain tumor + cafe au lait spots (not NF1 or mismatch repair deletion)
• Pilocytic astrocytoma on optic chiasm resected led to DI treated with DDAVP
• Little boy that kept on saying no, then said yes when I asked if he wanted to get out of that room
• Chubby little baby who finished his chemo and got to ring the bell and got balloons + a present
• TAR (thrombocytopenia with absent radii) - no forearm!
• Duchenne muscular dystrophy (completely atrophied legs)
• FAP + hepatoblastoma + desmoid tumor + b-catenin + fx
• Langerhans Histiocytosis (face); Hemophagocytic lymphohistiocytosis; Alveoli rhabodmyosarcoma; Adrenal cortical carcinoma (cushing)
• ALL (extramedullary - renal), NHL, HL, Wilms
• Sickle, SC, C w/persistent F, Bthal trait adopted girl, hereditary elliptocytosis (smear looked really cool)
• Branchial cyst
• When asked about funny moments in peds, friend says, "They don't really do funny things because they can't talk.  They just wriggle around a lot and sleep or cry."
• Nursery
• Catching babies!
• Watching a very tired mom take a peek at her child, smile, and say, "please take care of him!" as he's rolled away in isolation.
• 24+ hrs of labor!
• Baby delivery into the toilet!
• Others:
• Sitting in a car with an attending and an intern hearing about each of them talking about how their patient died.

Bipolar Mania

Psychiatry is very, very, very interesting! I got assigned to a few patients, including bipolar patients!  It's so difficult to interview them because they just talk 100 mph!  Initially I felt bad interrupting them, but if I didn't, I'd still be there interviewing them!  In the end, I just let them ramble, until I thought of a new question to ask.  The human brain is truly amazing.  I could be asking about how they slept, and they would respond well, then talk about how they slept in Iowa, and how they could get me a good deal at the hotel next door - things that are completely unconnected and untrue.  When the patient got worse, I couldn't even understand them because they were trying to speak so fast they'd end up mumbling.

Another patient had psychosis and apparently pulled a long piece of string from the side of my pants, and started raveling it.  All the while, they were doing the motion, and there was definitely no string.  Then the patient talked about how everyone in the hospital is acting and out to get them.  They would switch from being very nice and smiling to being completely guarded and suspicious and say things like "you're one of them, I'm not going to tell you anymore things" to admiring how our shoes are similar - all in 10 seconds.  In the meantime, they get distracted so easily that they couldn't even remember where they were or what year it is.  Perhaps they do know, but they just get distracted too quickly to be able to think of the right answer and respond.

Meanwhile, someone else didn't sleep at all the night before, yet still had an insane amount of energy.  Every time I said "okay, can we talk about...." they would get ready to get out of their seats and do something.  Apparently they were so restless they reorganized all the games in the activity center and drew on the walls.  The patient also kept on saying for me and my husband to go visit them, even though I told them that I didn't have a husband.  Then they said they could find me a nice doctor to marry.  Later on, they gave me a hug - kinda sweet, kinda nice, but also kind of sad b/c who knows if they really meant to give that hug.

One patient was such a nice patient.  When I first med them, they were so friendly and said they saw a sparkle in my eye.  They later said they were afraid I was going to leave, and gave me a hug.  It's so sad because I'm sure the patient was a great person, but this psychiatric problem has left them so dysfunctional.  They've been refractory to a lot of treatments, and their current treatment hasn't started to work yet.  I really hope they get better!

Paintballing!

So much fun! Paintballs are A LOT smaller than I expected!  I was thinking of something from...10 things I hate about you.  If those were the sun, then these paintballs today were like the earth.  Many of us (girls) were slightly concerned about the painful report we received from previous ballers, and warning was well heeded.  I was fortunate - did not get hit that often, or at close range, but others on my team were not so lucky.  One teammate was hit TWICE, by a friend too!  Oh man, she got welts that look like a ring of blood-filled blisters.  It looks pretty gruesome for sure.

We had played 3 games.  The first game consisted of mostly running around the forest.  I was so nervous initially, I could feel my heart beating and I think I might have even been shaking.  I was just kind of sitting on some sand bags behind a tree, and afraid to move to see the opposite team.  After seeing I wasn't getting anywhere, I decided to move to a ditch.  Lucky for me, people didn't really see me there in the corner, so I got lucky and shot 3 people or so.  Each round is single elimination, so if the paintball bursts on you, then you're out.  I think everyone was lucky then, so time ran out and it was a draw.  It was funny to see where people got hit: skidding the arm, right smack between the eyes (we got masks), and even in the "man area"(apparently he didn't feel it).

For the second game, our group of friends had to split up because the other team only had 3 people.  Right away, I tried to advance far so I could get a good angle and good hiding spot.  It was so muddy I could barely move, so I moved even farther forward.  After the game, a friend on the opposite team complained that I pelted him a million times while he was a bush, another friend said I hit him in the face and on his bare head, and I hit someone else on the head.  Oops...maybe I should be less vicious.   But turns out one of them got hit, but the ball didn't burst, and so she later got me back when there was maybe 1 minute left.  Sighs.

The last round was pretty disastrous.  We had planned to have some people go right, some left, and one up in the tower, but it turns out we had no idea how far left the field went.  I also got too impatient (progressively more so each game), didn't realize there were people on my right, and easily got pelted by 3 paintballs.  Yikes.  Meanwhile, the other team, completely flanked us by going through a trail on the left - while we thought we had reached the border.  Yup, 5 min and we were goners.

Anyhow, it was a lot of fun, and I'd love to go again! (if it weren't so expensive...)

Lives of Others

I like to talk to strangers.  I suppose that's the opposite of what parents teach their kids, but I've also found some very interesting stories.  I usually don't ask for people's names, but perhaps I'll meet one of these people again:

• While waiting for the plane, I met a couple from Alaska who just went to see their kid graduate from a Christian college to be a missionary in Japan.  
• I met this teacher who used to teach in Kentucky.  She's taught both lower income population and upper middle class kids.  She was describing how the new testing laws regarding grade school has put more pressure on teachers and kids.  While more effort is raised to bring kids up to par, it has also pressure more kids to drop out.  Hm, I wonder to what extent it's true.  Towards the end of the flight she told me she has MS and that's partly the reason she's reconsidering going back to work at Starbucks.  She was saying that although her condition is somewhat stable now, her last intensive course of medication wasn't doing anything, so now she isn't on anything.  The initial symptoms consisted of difficulty with balance and gait (foot drop).
• A couple where the wife is a pharmacy student and the husband considering changing careers.  
• This mother with a really adorable little kid.  Her husband actually works at my school and plays tennis!  We actually became facebook friends...haha. 
• A pilot who used to be the pilot for the director of some famous movie (sadly, I forgot who).
• Student in Utah who's going to college for degree in computer science and ballet.  Yup, he's a ballet dancer. 
• Child who travels alone back and forth via the plane every year because his parents are divorced.  When asked what his favorite hobby is, he says "computer games." Oddly enough, I sat next to him on the flight back.
• Somebody gave me the book he was reading, "Tao of Pooh."
• While I was in Korea...
• I met this British man while trying to figure out the bus system in Korea (not knowing how to read/write/speak Korean), who helped me find the right bus to reach Bukhan San (sp?)
• On one of the buses, I finally found a girl who spoke a tiny bit of English.  Turned out she's getting off the same stop as me, so she said she'd show me the way to the National Park.  Better yet, her mom is going to hike there too, so she told me to just go with her mom.  When she saw I had flip flops on to go hiking/climb a mountain, she let me borrow her shoes. They were kind of small, so it kinda hurt.  
• Hiking with the girls mom was amusing.  I didn't speak Korean, and she didn't speak English, so we had to mime most things.  I tried to learn a few words of Korean, but I think all I learned was "water"...which I'm still not sure whether it's "bul" or "mul."  The mom was so nice she even invited me to eat lunch with her after our hike.  
• While hiking at Bukhan San, I met one of the forest patrols for the park.  He spoke pretty good English! 
• The forest patrol guy had to go a different route, so then later I got directions from this other elderly man who once again didn't speak English, but he helped me take pictures :)
• On the way down from the hike, I ended up mostly getting directions/talking to this consultant (not sure what he consults).  Can't remember most of what he said, but one time he asked if I wanted a drink once we get down to the bottom of the mountain.  I thought he said "beer," so I said, oh no, I don't drink.  But it turns out it had been some other typical refreshing Korean drink that just sounded like beer. hahahaha...I think I kindly rejected the offer, and we parted ways after we reached the gate.  
• As I was walking through a traditional korean village (Namsangol Hanok Village) when I saw this white guy.  Having not spoken English for the whole day, it was nice to strike up a conversation in English.  Turns out he's half Korean and half Swedish, going to school in Sweden, and didn't speak any Korean either.  
• While in China we met this guy at one of the hotels who was just traveling through various parts of China for a couple of months.  He kinda tagged along with us for a little while at Yangshuo, and then we parted ways.
• While in Sierra Leone...
• While staying at one of the school's guest houses, I met this apparently popular Sierra Leone band. Sadly, I don't remember their names or the names of their band.  I didn't know they were well known in Sierra Leone until I later talked to my driver, Lahai, who started listing off his favorite songs by them.  
• There was a scientist from Belgium? Germany? (bad memory) who was also staying at the guesthouse.  He came to help out the Njala School's biochemistry lab for two weeks.  He also bought us drinks - how nice!  Although he did smoke - and I was half trying not to breath. 
• Some students from the states who were teaching the farming department how to properly handle livestock.  

SP POM II Final Exam

Phew, what a relief to know I passed an exam...need to remember to ask/do the following for future patients:

• Ask about diet/exercise
• Test for sensation
• Warn patient about thyroid exam/chest exam and ask permission to undrape
• Pull out and put back in leg rest
• Put patient's socks back on
• For chest pain, ask about nausea, if pain worsened by deep breath, listen to heart while lying flat.  Whether chest pain is exertional or positional.  Specifically write whether patient is or isn't taking aspirin.
• Ask/write age/gender
• Write negatives (e.g. no exacerbations)
• Write how other diseases (DM) are controlled
• Document abdominal exam and edema
• Sample differential for chest pain: 
• Acute coronary syndrome, MI, unstable angina,e tc.
• General angina, CHD, CAD, ischemia
• Pericarditis
• GERD, esophageal spasm, etc.
• Pulmonary embolism
• Aortic dissection or aneurysm
• Myocarditis

CMA reflections

Thankful for:

• Good rotation schedule: Although it wasn't what I had signed up for, it turned out to maybe even be better than what I had in mind at first.  I remember taking a lot of time trying to figure out what schedule would be the most advantageous, putting in all the permutations into the lottery, and asking a bunch of people what's good/bad.  But ultimately I guess God knows best.  What may work for everyone might not actually work for me considering I tend to be a slow starter.  So while many people said to start with Internal Medicine, it's probably for the best that I'm starting with Psychiatry, which appears not to be too intense (of course, that's relative).  Rest of my schedule: 
• Psychiatry, Neurology, Emergency Med
• Pediatrics, Ob/Gyn
• Internal medicine: BJC, Cardiology, Family Med
• Surgery
• Having a place to stay next year: Despite the uncertainty and slight drama, I'm thankful to have such good friends who I know won't abandon me, even though it may make their life a bit complicated.  But still have to figure out the details...
• Having a wonderful family and an adorable little brother who tells me riddles. 

Prayer for:

• Friends and their family: things don't always go as planned.  Even the worst things happen to good people.  It's always a mystery why God lets those things happen, and even though I know the answer is that "God has a plan for everything," sometimes, I want a better/clearer answer.  
• Family business: that my parents will be able to sell the house they're building.  
• Friends weddings - all the best to them, and that I'll be able to make it to them if possible.
• Step 1. Sighs.  

Things I don't understand:

• Job: reading about it is confusing. Even though I know he's supposed to show the epitome of being good and not forsaking God despite having so many problems - it seems like he still complains a lot. hm....

Advanced Physical Exam

Who would've thought that my most intimate interaction with anyone would be in a small room with two other students watching me? Yup, it's called advanced physical exam.  Every year, 120 or so confused medical students split up into teams of 3 to learn how to do a breast exam, pelvic exam, genital exam, and rectal exam on a real, live, standardized patient (these people had better be paid a good amount of moolah).*

Anyhow, I was paired up with two other guys, and so I got to go first with the breast and pelvic exam.  The whole thing was very professionally handled, but still, there were times where I couldn't believe how hard I had to press to milk for discharge or how difficult it was to find an ovary.  It also didn't help that I, being curious and having a tendency to ask way to many questions, was in the middle of a manual pelvic exam when I started asking all these questions of how exactly was I supposed to feel an ovary when my hand was twisted in the most awkward position ever.  But I suppose during the time I was so focused on the logistics of everything, I didn't have time to think about the strangeness of my situation.  Temperature test, forefinger in, middle finger on top, middle finger down, press down, insert speculum, retract fingers, keep speculum pointed down, open clamp, scrape os, close clamp, retract speculum while inspecting sides.  Then lube and insert fingers as above, test cervix mobility, turn fingers, move uterus, feel for uterus size, side sweeps for ovaries.  Although I wasn't able to find the sneaky little bugger (aka, the os) while my fellow students did, I was amused watching them struggle to remain calm during this ordeal as their hand shook and beads of sweat formed on their forehead.

It was also partly comforting and partly unusual when the male SP (standardized patient) told us that he had done many of these and had traveled around the country doing these.  In fact, the female SP said she enjoys being an SP - especially when she gets to be mean (oy!).  Anyhow, as the male SP was talking, he just casually dropped his trousers and continued talking to us as if nothing happened.  Observe, lymph nodes, pulse, check posterior, shaft, scoop and grasp cord, palpate 3 things, pull down skin to test for inguinal hernial with opposite finger, bare down. This time I learned being first wasn't good, so I got to go last.  Having watched this exam 3 times, I was confident.  "Lube, use thumbs to examine, left hand to retract, warn about cool sensation, touch, insert..."  But as the SP was walking me through the exam, his phone went off.  While I patiently waited for him, he reached for his phone and fumbled it until he finally managed to silence it.  Then he continued the exam as if nothing had happened.  "...sweep 360, press down and in, tell the patient what to expect, there, you've found the prostate, retract, squeeze, done."  I quickly said a thank you, and rushed to get out, unaware I had opened the door when the SP was still lacking his trousers.  Thankfully he just smiled and said they were all family anyways.

I'm thoroughly grateful for the SP's who have, in a sense, given up their body for science.

*Note: No SP's were harmed in the making of 120 med students.  

Please Vote for 6Dot!

My roommate from undergrad invented (yes, invented!) a portable Braille labeler for the blind, and she has asked me to forward this on.  She's taking time off grad school for this, and it really has made a difference in people's lives (if you can't tell, i'm so proud of her!!), so if you don't mind taking a bit of time, can you help her out by "liking" her video for a competition she's in?  It would be much appreciated! (Please see email below):

----------------------------

Hi All!

We are in a competition for our startup company, which is developing a portable Braille labeler that will change the lives of blind people around the world. We need your help to pull up in the rankings! Please do these FOUR QUICK STEPS to help us out!!

1. Go to this link, then click the word "LIKE" below the video: http://www.youtube.com/watch?v=VNUCJ1Ps_ng

2. Go to this link, then click the word "LIKE" next to the title "MIT 100K Entrepreneurship Competition": http://www.facebook.com/mit100k

3. Scroll down until you can find the video of 6dot Braille labeler, and click the word "LIKE" below the video. If you can't find our video, you may need to click "Older Posts" at the very bottom of the page.

4. Forward this email to any friends who wouldn't mind to give us a minute of help!

Thanks!!!
Karina Pikhart & Trevor Shannon

6dot Innovations Founding Team